Intervertebral Disc Protrusion Research Articles

The effect of lumbar multifidus muscle degeneration on upper lumbar disc herniation

PurposeThis study aimed to investigate the effect of lumbar multifidus muscle (MF) degeneration on upper lumbar disc herniation (ULDH).MethodsThis study used 3.0T magnetic resonance imaging (MRI) T2 axial weighted images to retrospectively analyze 93 ULDH patients and 111 healthy participants. Sixty-five pairs of participants were included in this study using propensity score matching (PSM). Cross-sectional area, fat infiltration area, anteroposterior diameter (APD), lateral diameter (LD), cross-sectional area of the bilateral multifidus muscles at the corresponding level, intervertebral disc area at the corresponding section, and visual analog scale (VAS) score for low back pain (LBP). For inter-group comparisons, we used the t-test, analysis of variance (ANOVA), Mann–Whitney U test, Kruskal–Wallis test, chi-square test, or Fisher's exact test, according to the type of data. We used Pearson correlation analysis to study the correlation between the VAS score and related indicators, and established a predictive model for upper lumbar disc herniation using the receive operative characteristic (ROC) curve analysis method. Finally, univariate and multivariate logistic regression analyses were performed to establish a predictive model for the risk of high lumbar disc herniation.ResultsWe compared the fat areas at the lumbar vertebral levels L1/2, L2/3, and L3/4, as well as the left lateral diameter (LD) (MF), L1/2 left lumbar multifidus muscle index (LMFI), and L1/2 total fat infiltration cross-section area (TFCSA), and found significant differences between the case and control groups (P < 0.001). Furthermore, we observed a significant positive correlation (P < 0.05) between the VAS scores and multiple muscle indicators. Additionally, we developed ROC prediction models to assess the risk of lumbar intervertebral disc protrusion at the L1/2, L2/3, and L3/4 levels, with the results identifying L1/2 TFCSA, L2/3 TFCSA, and L3/4 relative psoas major muscle cross-section area (rPMCSA) as the most predictive indicators. Finally, univariate and multivariate logistic regression analyses showed that the L1/2 rPMCSA, L2/3 TFCSA were significantly associated with the risk of lumbar intervertebral disc protrusion in both models.ConclusionDegeneration of the MF is significantly correlated with the occurrence of ULDH, and the larger the area of fat infiltration in the MF, the more obvious the lower back pain in ULDH patients. In addition, TFCSA can serve as an indicator of the occurrence of ULDH.

Spinal magnetic resonance imaging in cats: differences in clinical significance of intervertebral disk extrusion, intervertebral disk protrusion, and degenerative lumbosacral stenosis.

To determine the occurrence of degenerative changes affecting the vertebral column in cats, assess their clinical significance, and determine the occurrence in cats with intervertebral disk herniation compared to other spinal diseases. 114 client-owned cats. Hospital records were retrospectively reviewed for cats with suspected myelopathy that had undergone spinal MRI. Signalment; history; neurological examination; neurolocalization; primary diagnosis; presence, type, and location of intervertebral disk herniation; and presence and location of other degenerative spinal changes (intervertebral disk degeneration [IVDD], spondylosis deformans [SD], end plate changes, dorsal compressions [DC], and foraminal stenosis [FS]) were recorded. 70% of cats showed at least 1 spinal degenerative change. The most common change was IVDD, followed by SD and intervertebral disk protrusion (IVDP), while intervertebral disk extrusion (IVDE), end plate changes, DC, and FS were uncommon to rare. Primary complaint was attributed to a degenerative condition in 22% of cats, including 100% with IVDE, 9% with IVDP, and 43% with degenerative lumbosacral stenosis (DLSS). The occurrence of degenerative spinal changes and number of intervertebral disks affected by IVDD significantly increased with age and body weight. Age was positively correlated with the occurrence of SD and DLSS. Intervertebral disk degeneration, IVDP, SD, DC, and FS were more prevalent in the lumbosacral junction. Cats with IVDD were significantly more likely to show IVDE and IVDP. This study revealed that in a population of cats presenting for signs of myelopathy, IVDE was always responsible for the clinical presentation, DLSS was commonly considered incidental, and IVDP was infrequently related to neurological signs.

Exosome-mediated Repair of Intervertebral Disc Degeneration: The Potential Role of miRNAs.

Intervertebral disc degeneration (IVDD) is a serious condition that manifests as low back pain, intervertebral disc protrusion, and spinal canal stenosis. At present, the main treatment methods for IVDD are surgical interventions such as discectomy, total disc replacement, and spinal fusion. However, these interventions have shown limitations, such as recurrent lumbar disc herniation after discectomy, lesions in adjacent segments, and failure of fixation. To overcome these shortcomings, researchers have been exploring stem cell transplantation therapy, such as mesenchymal stem cell (MSC) transplantation, but the treatment results are still controversial. Therefore, researchers are in search of new methods that are more efficient and have better outcomes. The exosomes from stem cells contain a variety of bioactive molecules that mediate cell interactions, and these components have been investigated for their potential therapeutic role in the repair of various tissue injuries. Recent studies have shown that MSC-derived miRNAs in exosomes and vesicles have therapeutic effects on nucleus pulposus cells, annulus fibrosus, and cartilage endplate. miRNAs play a role in many cell activities, such as cell proliferation, apoptosis, and cytokine release, by acting on mRNA translation, and they may have immense therapeutic potential, especially when combined with stem cell therapy. This article reviews the current status of research on intervertebral disc repair, especially with regard to the latest research findings on the molecular biological mechanisms of miRNAs in MSC-derived exosomes in intervertebral disc repair.

Genetic factors in the etiology of intervertebral disc herniation and protrusion

Genetic factors in the etiology of intervertebral disc herniation and protrusion

Perioperative epidural catheter analgesia as a component of a multimodal analgesic approach in a dog with thoracic hemivertebrae and kyphosis undergoing thoracic vertebral stabilisation

AbstractA 4‐year‐old, male, neutered French bulldog weighing 13.5 kg presented with urinary and faecal incontinence, progressive, non‐painful paraparesis and pelvic limb proprioceptive ataxia. Magnetic resonance imaging revealed a T12 constrictive myelopathy in association with multiple thoracic vertebral malformations, and mildly impinging thoracic intervertebral disc protrusions. Additionally, there was a sacral axial defect and degenerative lumbosacral stenosis. Surgical treatment comprised bilateral dorsal vertebral stabilisation of T9–T13. This case report summarises the peri‐anaesthetic management, which included an ‘in‐plane’ ultrasound‐guided placement of an epidural catheter at the level of L3–L4 and advancement cranially to T12 as a component of a multimodal analgesic regimen. Following the cessation of postoperative epidural bupivacaine administration, the patient remained comfortable without requiring rescue analgesia, and was discharged within 24 hours of surgery. At the latest recheck 5 months after surgery, the dog's neurological status remained static. This technique and application remain unexplored in existing veterinary literature.

Computer Аssessment of the Risk of Нerniated Protrusions of the lntervertebral Discs of the Neck Based on MRl Data

The purpose of the research is assessment of the risk of herniated protrusions of intervertebral discs C4-C5, C5-C6 and C6-C7 of the cervical spine according to MR/ examination.Methods. Тhe biomechanics of the physiological processes of this department has been studied on the basis of MR/ data. A computer program «A method for assessing the risk of herniated protrusions of intervertebral discs of the cervical spine based on the results of an MRI examination» has been developed and tested. The measurements required for the above assessment were obtained during the evaluation of the MR/ examination of a particular patient, after which the data was entered into the program. Тhe calculation results were compared with the database previously obtained by the authors in the course of experimental and clinical studies.Results. Тhe model we use correctly describes the mechanical features of the vertebral junction, since it takes into account the most significant features of their structure, which affect the change in the length of the arms of the levers and the force of pressure on the center of the intervertebral disc. Based on magnetic resonance imaging data, the height of the intervertebral disc at the level of the anterior edges of the vertebral bodies and the АV value were determined, and tg was calculated. For a particular patient, the risk of intervertebral disc protrusion was obtained at the C4-C5, C5-C6 and C6-C7 levels.Conclusion. Тhe test results of the program for assessing the risk of developing an intervertebral disc protrusion in the cervical spine make it possible to describe dynamic phenomena in the cervical spine and predict an unfavorable outcome of pathology at the preclinical stage, even in the absence of clinical manifestations.

Magnetic resonance imaging-based classification of the myodural bridge complex and its influencing factors

Cerebrospinal fluid (CSF) circulation is considered the third circulation of the human body. Recently, some scholars have proposed the myodural bridge (MDB) as a novel power source for CSF flow. Moreover, the suboccipital muscles can exert a driving force on the CSF via the MDB. This hypothesis is directly supported by head rotation and nodding movements, which can affect CSF circulation. The MDB has been validated as a normal structure in humans and mammals. In addition, the fusion of MDB fibers of different origins that act in concert with each other forms the MDB complex (MDBC). The MDBC may be associated with several CSF disorder-related neurological disorders in clinical practice. Therefore, the morphology of the MDBC and its influencing factors must be determined. In this study, T2-weighted imaging sagittal images of the cervical region were analyzed retrospectively in 1085 patients, and magnetic resonance imaging (MRI) typing of the MDBC was performed according to the imaging features of the MDBC in the posterior atlanto-occipital interspace (PAOiS) and posterior atlanto-axial interspace (PAAiS). The effects of age and age-related degenerative changes in the cervical spine on MRI staging of the MDBC were also determined. The results revealed four MRI types of the MDBC: type A (no MDBC hyposignal shadow connected to the dura mater in either the PAOiS or PAAiS), type B (MDBC hyposignal shadow connected to the dura mater in the PAOiS only), type C (MDBC hyposignal shadow connected to the dura mater in the PAAiS only), and type D (MDBC hyposignal shadow connected to the dura mater in both the PAOiS and PAAiS). The influencing factors for the MDBC typing were age (group), degree of intervertebral space stenosis, dorsal osteophytosis, and degenerative changes in the cervical spine (P < 0.05). With increasing age (10-year interval), the incidence of type B MDBC markedly decreased, whereas that of type A MDBC increased considerably. With the deepening of the degree of intervertebral space stenosis, the incidence of type C MDBC increased significantly, whereas that of type A MDBC decreased. In the presence of dorsal osteophytosis, the incidence of type C and D MDBCs significantly decreased, whereas that of type A increased. In the presence of protrusion of the intervertebral disc, the incidence of type B, C, and D MDBCs increased markedly, whereas that of type A MDBC decreased considerably, with cervical degenerative changes combined with spinal canal stenosis. Moreover, the incidence of both type C and D MDBCs increased, whereas that of type A MDBC decreased. Based on the MRI signal characteristics of the dural side of the MDBC, four types of the MDBC were identified. MDBC typing varies dynamically according to population distribution, depending on age and cervical degeneration (degree of intervertebral space stenosis, vertebral dorsal osteophytosis formation, simple protrusion of intervertebral disc, and cervical degeneration changes combined with spinal canal stenosis, except for the degree of protrusion of the intervertebral disc and the degree of spinal canal stenosis); however, it is not influenced by sex.

Efficacy of Medical Ozone as an Adjuvant Treatment in Dogs with Intervertebral Disc Protusions—A Retrospective Study

Ozone-therapy is used in humans as a coadjutant treatment in intervertebral disc diseases due to its analgesic, anti-inflammatory and antioxidant effects. References in dogs are scarce and limited to clinical cases (intradiscal/paravertebral infiltrations). The aim of this study was to assess the use of medical ozone (MO) as an adjunctive treatment in dogs with intervertebral disc protrusions (Hansen Type II/Chronic). A retrospective study was conducted in dogs diagnosed with intervertebral disc protrusions by MRI/CT in which MO was used as an adjuvant therapy to conventional medical treatment. Neurological examination and quality of life (QL) at the beginning and end of study were recorded, as well as posology and possible side effects. A total of 21 patients of different breeds and sex with a mean age of 12 years were included in this study. Results showed pain relief (7 ± 3 days) and improvement of neurologic signs (11 ± 9 days) with a consequent increasement in QL (13 ± 9 days). Thirteen out of the twenty-one patients (62%) showed a complete remission of the clinical signs. No serious adverse effects were observed. Medical ozone could be a potential complementary therapy to medical treatment in dogs with intervertebral disc protrusions. Prospective studies are necessary.

Retracted: Clinical Effect of the Treatment of Lumbar Intervertebral Disc Protrusion

Retracted: Clinical Effect of the Treatment of Lumbar Intervertebral Disc Protrusion

Prevalence, MRI findings, and clinical features of lumbosacral intervertebral disc protrusion in French Bulldogs diagnosed with acute thoracic or lumbar intervertebral disc extrusion

Prevalence, MRI findings, and clinical features of lumbosacral intervertebral disc protrusion in French Bulldogs diagnosed with acute thoracic or lumbar intervertebral disc extrusion

Computed tomography myelography description of pneumorrhachis secondary to a degenerative intervertebral disk disease in a cross‐breed dog

AbstractA 9‐year‐old, male, neutered, cross‐breed dog was presented for a 6‐month history of spinal pain, mild pelvic limbs proprioceptive ataxia and discrete ambulatory paraparesis. Computed tomography myelography identified focal gas accumulation in the left aspect of the vertebral canal at the level of T11–T12, resulting in moderate extradural spinal cord compression. Minor chronic intervertebral disk protrusion was also identified at this level with no evidence of spinal cord compression. An encapsulated space‐occupying gas accumulation was identified and removed during a left‐sided T11–T12 hemilaminectomy. On histopathological analysis, the capsule was formed by connective and inflammatory tissue. Early neurological deterioration following surgery was observed due to persistent extradural material causing spinal cord compression. Widening of the previous hemilaminectomy window was performed to remove the compressive material, and progressive improvement was noted during the following weeks. This is the first case of computed tomography myelography description of pneumorrhachis in a dog.

Accuracy of low-field magnetic resonance imaging for differentiating intervertebral disc extrusions and protrusions at the lumbosacral disc space in dogs.

MRI features differentiating extrusion from protrusion in thoracolumbar discs have been published, however little specifically evaluates the lumbosacral disc. The high prevalence of degenerative changes in apparently normal animals complicates assessment of this region and features relevant elsewhere in the spine may not apply. The aims of this study were to determine the accuracy of MRI in differentiating IVDE and IVDP at the lumbosacral disc space in dogs and determine which MRI characteristics discriminate between IVDE and IVDP. MRI examinations from dogs with surgically confirmed IVDE or IVDP at the lumbosacral disc space were collected retrospectively (2011-2019). Two radiologists independently recorded a diagnosis of IVDE or IVDP, gave a confidence rating, and evaluated specific MRI features. Univariable statistical analysis was performed to identify which MRI characteristics might help distinguish IVDE from IVDP. 117 dogs with lumbosacral IVDE (n = 16) or IVDP (n = 101) were included. Features associated with IVDE were in concordance with previous studies and included interruption of the dorsal annulus, suspected epidural hemorrhage, dispersed (rather than confined) intervertebral disc herniation on T2W sagittal images, lateralized intervertebral disc herniation and displacement of the cauda equina. Overall diagnostic accuracy was 68.8% and interobserver agreement was fair (κ = 0.37), which is lower than has been reported in thoracolumbar disc herniation, but accuracy increased to 85.3% with substantially improved agreement (κ = 0.87) in "confident" diagnoses. MRI characteristics used in differentiating thoracolumbar IVDE and IVDP can be extrapolated to the lumbosacral intervertebral disc space, but diagnostic accuracy in low-field MRI is lower than previously reported in herniations involving the thoracolumbar spine.

Head tilt as a clinical sign of cervical spinal or paraspinal disease in dogs: 15 cases (2000-2021).

To characterise head tilt as a rare clinical sign of cervical spinal or paraspinal disease in dogs. Retrospective single-centre case-series study of dogs with head tilt and cervical spinal or paraspinal disease in the absence of intracranial abnormalities. Descriptive statistics were used. Fifteen dogs met the inclusion criteria of this study. Median age at onset was 6 years (range 2.5 to 12 years). Onset of neurological signs was mainly chronic (9/15, 60%). Most common presenting complaints included head tilt (9/15, 60%) and cervical hyperaesthesia (8/15, 53%). Most common neurological findings included head tilt (15/15, 100%), generalised proprioceptive ataxia and tetraparesis (6/15, 40%) and cervical hyperaesthesia (8/15, 53%). Diagnoses included post-operative complication of C2 spinal nerve root mass removal (2/15, 13%), C3-C4 intervertebral disc extrusion (2/15, 13%), cervical paraspinal myositis (2/15, 13%) and one of each: C2 vertebral malformation, C2 spinal nerve root mass, C1-C2 meningioma, C2 vertebral fracture, C4-C5 intervertebral disc extrusion, C4 vertebral body mass, C5-C7 osseous-associated cervical spondylomyelopathy, and concurrent C5-C6 and C6-C7 intervertebral disc protrusions. Two dogs were euthanased shortly after diagnosis and two of 15 were dogs lost to follow-up. No post-mortem examination was performed for these cases. For the 11 of 15 remaining dogs, head tilt resolved in eight of 15 (53%) dogs after treatment of the underlying condition and in three of 15 (20%) dogs, it remained static. Head tilt can be a rare clinical sign of cervical spinal or paraspinal disease in dogs.

Treatment of Canine Disc-Associated Cervical Spondylomyelopathy with a Cervical Distraction-Stabilization Technique (C-LOX Combined with LCP Plate) and Clinical Outcomes.

Canine disc-associated cervical spondylomyelopathy (DA-CSM) is a form of caudal CSM, characterized by the compression of the spinal cord and nerve roots due to an intervertebral disc protrusion. It is more frequent in large canine breeds. A variety of surgical techniques has been proposed for DA-CSM. The aim of the study was to evaluate the outcomes of a cervical distraction-stabilization technique using an intervertebral anchored fusion device (C-LOX) combined with a locking compression plate (LCP plate) for the treatment of DA-CSM in dogs, based on clinical and radiographical follow-up data. Thirteen dogs affected by DA-CSM were included in the study. After the surgical procedure, an improvement in neurological status was documented in 9/13 cases. This cervical distraction-stabilization technique seems to be a valuable surgical alternative to treat this canine pathology.

The effect of lumbosacral transitional vertebra on lumbar spine degeneration and spondylolisthesis among patients with low back pain.

To examine the impact of lumbosacral transitional vertebra (LSTV) on lumbar spine degeneration, disc protrusion, and spondylolisthesis among patients with low back pain. The records of the patients who had undergone anterioposterior lumbar radiographs and lumbar magnetic resonance imaging (MRI) for low back pain between November 2014 and September 2021 were extracted retrospectively and assessed for eligibility. Of the remaining patients, those with LSTV were assigned as "case group." Age- and sex-matched patients without LSTV were assigned as "control group." On digitalized lumbar MRIs, Modic degeneration (type I-III) and Pfirrman's disc degeneration (grade I-V) immediately cephalad to the transitional level were evaluated; intervertebral disc height (mm), disc protrusion (mm), and percentage of vertebral slippage (%) were measured. Of the 501 patients with low back pain, 128 ineligible patients were excluded; 113 patients with LSTV and 117 age- and sex-matched controls were included in the study. LSTV group revealed decreased intervertebral disc height, increased vertebral endplate degeneration, and slippage, as well as increased disc degeneration and protrusion when compared with controls (p < 0.001). Patients with type III LSTV had greater disc protrusion and higher percentage of slippage compared to those with type I LSTV (p = 0.008 and p = 0.009, respectively). Vertebral endplate degeneration, disc height, and disc degeneration did not differ across categories of LSTV type. Lumbosacral transitional vertebra malformation is related to decreased intervertebral disc height, increased disc degeneration, vertebral endplate degeneration, disc protrusion, and slippage above the level of transition. Patients with type III LSTV revealed the highest percentage of slippage and disc protrusion.

Magnetic resonance imaging and neurologic characterization of combined osseous- and disc-associated cervical spondylomyelopathy in dogs.

Although both disc- or osseous-associated forms of cervical spondylomyelopathy (CSM) are observed in the same dogs, this combined form has not been thoroughly evaluated. To describe imaging characteristics of dogs with concurrent disc- and osseous CSM and investigate an association between findings on neurological examination and imaging. Sixty dogs with disc and osseous-associated CSM from 232 CSM-affected dogs. Retrospective study. Dogs diagnosed via high-field MRI with a combination of intervertebral disc (IVD) protrusion and osseous proliferation of articular processes, dorsal lamina, or both were identified. Large and giant breed dogs were grouped according to whether combined compressions were at the same site or different sites. Statistical methods were used to investigate the association and relationship between variables. Thirty-five out of 60 (58%) were large breeds and 22/60 (37%) were giant breeds. Mean and median age was 6.6 and 7 years respectively (range, 0.75-11 years). Forty of the 60 dogs (67%) had concurrent osseous and disc-associated spinal cord compression in the same location. This was considered the main compression site in 32/40 (80%) dogs. Dogs with osseous- and disc-associated compressions at the same site were more likely to have a higher neurologic grade (P = .04). A substantial percentage of dogs with CSM present with concomitant IVD protrusion and osseous proliferations, most at the same site. Characterizing this combined form is important in the management of dogs with CSM because it could affect treatment choices.

Small animalReview

Spinal problems resulting from intervertebral disc extrusion or protrusion are commonly encountered in clinical practice, with presentations ranging from chronic pain and paresis to acute paraplegia. Small breed chondrodystrophic dogs are predisposed to these problems. Surgery is often indicated, especially in severe acute cases. Three recent papers look at different aspects of disc herniation.

Early disc degeneration in radiotherapy-treated childhood brain tumor survivors

BackgroundChildhood brain tumor (BT) survivors have an increased risk of treatment-related late effects, which can reduce health-related quality of life and increase morbidity. This study aimed to investigate lumbar disc degeneration in magnetic resonance imaging (MRI) in adult survivors of radiotherapy-treated childhood BT compared to age and sex-matched population controls.MethodsIn this cross-sectional comparative study, 127 survivors were identified from hospital registries. After a mean follow-up of 20.7 years (range 5–33.1), 67 survivors (mean age 28.4, range 16.2–43.5) were investigated with MRI and compared to 75 sex-matched population-based controls. Evaluated MRI phenotypes included Pfirrmann grading, , intervertebral disc protrusions, extrusions, and high-intensity-zone-lesions (HIZ). Groups were also compared for known risk factors of lumbar intervertebral disc (IVD) degeneration.ResultsChildhood BT survivors had higher Pfirrmann grades than controls at all lumbar levels (all p < 0.001). Lumbar disc protrusions at L4-5 (p = 0.02) and extrusions at L3-4 (p = 0.04), L4-5 (p = 0.004), and L5-S1 (p = 0.01) were significantly more common in the BT group compared to the control. The survivor cohort also had significantly more HIZ-lesons than the controls (n=13 and n=1, p=0.003). Age at diagnosis was associated with lower degree of IVD degeneration (p < 0.01). Blood pressure correlated with IVD degeneration (P < 0.05).ConclusionsSigns of early disc degeneration related to tumor treatment can be seen in the IVDs of survivors. Disc degeneration was more severe in children treated in adolescence.

Syringomyelia secondary to Thoracic Intervertebral Disc Protrusion: A rare condition

Spinal spondylosis is an extremely common problem among the middle-aged and elderly population. However, it is an extremely rare cause of syringomyelia in clinical practice. The differentiation between syringomyelia and hydromyelia is not always straightforward and rather exhaustive. Spinal cord compression and instability are the proposed mechanisms of injury-causing syringomyelia. Symptomatic presentation depends primarily on the location of the syrinx within the neuraxis, be it motor, sensory or autonomic disturbance. There were abundant of successful cases in the past, whereby surgical interventions can regress the appearance of syringomyelia in magnetic resonance imaging. However, there was a mixed result in terms of patients' symptom. There were only 6 reported articles of syringomyelia secondary to cervical spondylosis found worldwide. We describe a case of T11/T12 thoracic intervertebral disc protrusion causing long segment syringomyelia till conus medullaris.

Successful conservative management of epidural gas accumulation and haematoma formation following a lateral corpectomy in a dog

AbstractA 9‐year‐8‐month‐old, male, neutered labrador crossbreed dog was presented for evaluation of a chronic, progressive pelvic limb ataxia and thoracolumbar hyperaesthesia. The patient was diagnosed with a T12–T13 intervertebral disc protrusion and treated surgically with a lateral corpectomy procedure. After an initial post‐operative improvement, the dog acutely deteriorated to the point of severe non‐ambulatory paraparesis, with recurrence of thoracolumbar hyperaesthesia. A computed tomography scan revealed the presence of epidural gas accumulation and haematoma at the corpectomy site, causing moderate spinal cord compression. The patient was treated conservatively with strict rest and analgesia with subsequent neurological improvement. At the recheck appointment 6 weeks after surgery, the dog had demonstrated improvement from its pre‐surgical neurological status.